1. Obesitology 101 Dr. Ron Eagar Pager (303) 508-3154 E-mail: rmeagar@aol.comrmeagar@aol.com April 2001

2. 2 What Is It ? Overfat (not necessarily overweight; may be muscular) Defined by Body Mass Index (one method) – Formula = weight (in kilograms)/height (in meters squared) Or see chart – Normal range: 19 – 25 or below 85% Overweight = BMI 85th – 95 th or #25 – 30 Obesity = BMI above 95% or #30+ Other methods: “visual test”, skin folds, water immersion

3. 3 Current Statistics (NHANES III Study 1988-94) Overweight children = 14% Obese children = additional 11% A twofold increase since 1993 Teen obesity in Mexican-Americans = 14+% and in African-American girls 16.3% Adult Americans = 33% above BMI 80% (58 million people) Greater in Northeast and Midwest USA

4. 4 Why Worry - I ? Risk of adult obesity 79% if obese child has one obese parent (< 10 years old) Doubles if two obese parents If > 10 year old child, body size itself correlates with obesity

5. 5 Why Worry – II ? Enormous personal and economic costs Increased BMI correlates with health service use and costs 1995 costs = $99.2 billion (5.7% of U.S. health care)

6. 6 Why Worry – II ? (continued) 1994 cost of lost job productivity = 39.2 million job days and $3.9 billion Increased restricted activity days, bed days, and physician’s visits Out-of-pocket expense as insurance coverage is minimal

7. 7 Why Worry – III ? Mental and physical consequences Low self-esteem/social isolation/depression/ eating disorders CV/pulmonary/hypertension/premature atherosclerosis Skeletal: SCFE, hip aseptic necrosis, Blount’s disease (tibial bowing)

8. 8 Why Worry – III ? (Continued) Metabolic: hyperlipidemia/NIDDM/ cholecystitis/colon CA Sedentary lifestyle/sleep abnormalities Syndrome X: hypertension, dyslipidemia, and NIDDM Hepatic steatosis/hepatitis Breast cancer

9. 9 Pathways to Obesity Genetics versus Environment Identical twins raised apart have similar physiques despite adoptive parents If raised by obese adoptive parents, tend to be obese themselves Recent genetic mutations being identified – For example, leptin/receptor, proopiomelanocortin, and adipocyte differentiation factor peroxisome- proliferator-activated receptor gamma 2

10. 10 Possible Environmental Contributors Food availability/portion size/high fat/ cholesterol composition (e.g. fast foods, snacks, soft drinks) Sedentary lifestyle Television/computer viewing time Psychosocial factors and psych medications

11. 11 Rare Endocrine Causes of Obesity Hypothyrodism (sluggish, cold intolerance, low pulse/blood pressure) Cushings Syndrome (short, buffalo hump, acne, hypertension, striae, moon facies) Polycystic Ovarian Syndrome (irregular menses, hirsutism)

12. 12 Rare Endocrine Causes of Obesity (continued) Prader-Willi and Laurence-Moon-Bardet- Biedl Syndromes Insulin resistance and NIDDM/acanthosis nigricans All above are rare if normal height or tall

13. 13 Medical Evaluation Clinical examination/BMI/stigmata? Possible labs (individualized) – Fasting lipid profile, chemistries, glucose, and insulin levels – Thyroid function tests and hand/wrist bone age – If AN: postprandial serum and glucose – Serum AM cortisol and 24-hour urinary cortisol – Chromosome studies (very rare, e.g. Turners XO)

14. 14 Treatment Options (Energy Eaten versus Energy Expended) Check if teen motivated Set reasonable goals/rewards (behavior mod)/1-2 lbs/week Practice good nutrition/change eating-related habits – “Stoplight” diet – Weight Watchers program – High protein/fat/low cholesterol diet

15. 15 Treatment Options (continued) Get active (20–30 minutes aerobic/day) Decrease TV/computer viewing time Solicit age-appropriate support/individual counseling Only weigh every 2 weeks

16. 16 Pharmacotherapy (Combined with diet and exercise) None to date with long-term benefit Fenfluromine (Pondimin) and dexphenfluromine (Redux) removed from market New sibutramine (Meridia), psychostimulant, and orlistat (Xenical), lipase inhibitor preventing fat absorption

17. 17 Pharmacotherapy (continued) No herbal ma-huang or ephedrine due to dangerous side effects Future: leptin and leptin receptors Very rarely surgery (Ileojejunal bypass)

18. 18 Summary of What Works No magic bullet/combined approach Increase exercise tolerance and aerobic capacity Decrease percentage of fat in diet Emphasize slowing of weight gain versus weight loss Provide ongoing group support and followup Teach behavioral modifications for lifetime Have patience with your patients

19. 19 Finale Model programs/your experiences Questions ??? Thank You